Do you know someone who always looks a little grumpy, mad, or sad? She may have what experts call 'perma frown.'

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Charlize Theron may have it. Kristen Stewart (pictured at far left) looks like she’s got it. And many people would say Victoria Beckham (right) has it bad. Dermatologists call it “perma frown." A popular YouTube video gave it a much more "street" name: bitchy resting face, affectionately known as BRF.

It turns out there are actually a lot of women who worry that their neutral face is not so neutral – they know they may look stand-offish, angry, or even mean. Concerns run so high, some seek dermatological interventions and even plastic surgery to put their lips into more of an upturned smile.

“There is no formal term 'perma frown' in dermatology, but it probably gets used in offices regularly when a patient comes in complaining about it, or a dermatologist is trying to explain to the patient what her options are for addressing her concerns of people always thinking she looks sad or angry," said Jessica J. Krant, MD, MPH, a New York City-based dermatologist.

You have perma frown when:

The downward corners of your mouth create an appearance of frowning even at rest.

You have permanent frown lines between your eyebrows, and a heavier and lower eyebrow resting height.

Hollows under your eyes make you appear to be sad or dejected constantly, when in fact you aren't even tired.

“There are a few facial characteristics that we [humans] read both consciously and subconsciously on each other's faces that determine the subtle details of social interaction,” Dr. Kant explained. “'Perma frown' is an expression that captures all of those facial characteristics together in a single term.”

A Comic With a Natural Scowl Makes a YouTube Splash

Comedian Taylor Orci says she was one of those people who has always had a natural scowl, even when happy, and that strangers have come up to her to ask her what is wrong and tell her to smile. So she created and starred in a humorous short video on bitchy resting face that has gotten more than three and a half million views on YouTube and brought BRF to widespread public attention.

“Bitchy resting face is not about the person's face, it as about the people who perceive the face to be unpleasant,” said Orci. “I imagine that's why it's funny and why the video was so popular.” She thinks women in particular feel pressured about their looks, and in some ways are blamed “for having faces that aren’t naturally pleasant all the time.” It is meant to be a spoofy public service announcement with a pithy message in defense of women who do not smile and look gleeful all the time.

Orci believes these women should be left in peace, but some experts seem to believe that there is an emotional and social component to perma frown that we should pay attention to.

The Face as the Window to Feelings

“When someone always seems to be frowning, even if they themselves don't realize it, it can affect areas of their lives they don't even consider,” said Kant.

Psychologists and therapists see perma frown as not merely a dermatological issue.

“Expressions are a measure of how we feel inside, and people are born with certain predispositions to carry their facial expression in a certain way,” said Simon Rego, PhD, Director of the CBT [Cognitive Behavioral Therapy] Training Program at Montefiore Medical Center/Albert Einstein College of Medicine in New York.

“Sometimes it's biological or genetic and other times psychological or learned, but even in the case of the latter, we all tend to show -- and identify -- the same facial expressions as being tied to certain emotions," said Dr. Rego. "For example, [in psychological tests] most people will guess that someone is sad when shown a picture of someone frowning, and will also pick the face that is frowning when asked to identify someone who may be sad in a set of pictures.”

Then again, for some people, BRF may be a way to hide true feelings. One Hollywood psychiatrist suggests that it is a strategy of stars. “It is actually a common occurrence among Hollywood celebrities,” says Sheenie Ambardar, MD, a psychiatrist based in West Hollywood. “I think it may indicate a bit of self-absorption and a touch of insecurity, but not necessarily a serious psychological problem. People who smile readily may or may not be any happier than people who don't smile easily. There is no way to know for sure what a person is thinking and feeling inside, despite their outward appearance."

Does BRF Have Physical or Emotional Causes -- or Both?

Kant says many things contribute to perma frown. “It can be caused by genetic factors in skin quality, anatomic factors in muscle arrangement under the skin, and of course lifestyle factors,” she said. “This includes smoking, sun damage, and other factors that create more wrinkles. Also, skin folds can exaggerate a tendency toward it that starts genetically in youth.”

Lisa Bahar, LMFT, LPCC, a family therapist, in Dana Point, Calif., thinks facial changes like BRF can be caused by our emotions. “Expressions are generally based on bodily sensations, which are directly correlated to emotions,” said Bahar. The emotion might be anger, rage, envy, jealousy, loneliness, depression, sadness, or hopelessness. These emotions can create bodily sensations that are expressed in our faces. “How we see the world is expressed in our facial expressions, which is read primarily by the expression in the eyes and the mouth,” she said.

By the same token, can perma frown cause someone to feel bad or depressed?

“There's been some research that suggests that emotions and the facial expressions that go along with them are bidirectionally influenced,” said Rego. “In other words, there's a two-way street between emotions and facial expressions: Most people understand that they smile when they feel happy and frown when they feel sad. But few know that when the facial muscles that are used to create a smile are activated it can generate feelings of happiness. By the same token, when the facial muscles that are used to create a frown are activated it can generate feelings of sadness.”

Fixing Her Frown Lines Made This Woman Smile

When Ashley Kingsley of Denver began the journey toward 40, she decided she wanted to make some changes. The dent in her forehead was one thing. It was inherited from her dad, and worsened by squinting over the years, she said. But as she began the journey toward transforming her appearance she realized there was another issue: BRF. She began the transformation in a dermatologist’s office.

“I am a pretty happy person,” said the married mom of two in an interview. She also blogs about her experiences in Journey to 40. “ I didn't like it when I looked in the mirror. It affected my self-esteem. In getting the work done, I was hoping to feel better about myself when looking in the mirror. This has been achieved.”

“I truly have BRF because of genetics and not wearing my glasses; from constant squinting over the years. But I don't think it has affected me deeply internally. Now, I am ready to look within and start taking some power over my body, mind and spirit. So, I am focusing on Me. I just so happened to start at the dermatological level," she said.

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